Expanding Retrograde Saphenous Vein Graft Aneurysm Treated With Endovascular Coiling

Saphenous vein graft aneurysm fistula formation causing right heart failure: an unusual presentation

Saphenous vein graft aneurysm (SVG) formation after coronary artery bypass grafting is a rare complication of the surgery. We present a case of a 68-year-old man with an unusual presentation of such an aneurysm. Thirty-four years after his initial bypass surgery, the patient presented with a fistula formation into his right atrium from a vein graft aneurysm. Late aneurysm formation is thought to occur secondary to atherosclerotic degeneration of the SVG with background hypertension and dyslipidaemia accelerating the process. Diagnostic modalities used to investigate SVG aneurysms include computed tomography, transthoracic echocardiogram, magnetic resonance imaging and cardiac catheterisation. Aneurysms with fistula formation historically require aggressive surgical intervention. Resection of the aneurysm with subsequent revascularisation if required is the surgical norm. SVG aneurysm with fistula formation into a cardiac chamber is a rare complication of coronary artery bypass grafting (CABG), which can occur with atypical presenting symptoms. Physicians should keep in mind the possibility of this occurring in post-CABG patients presenting with heart failure and a new murmur.

Thrombosis of a large saphenous vein graft aneurysm leading to acute myocardial infarction 21 years after coronary artery bypass grafting: role of cardiac multi-slice computed tomography

We report a case of a 74-year-old male, who presented with an acute ST elevation posterior wall myocardial infarction (MI) 21 years following revascularization with three saphenous vein grafts (SVGs) to the left and right coronary arteries. In coronary angiography (CAG), the dilated SVG to the first marginal branch of the circumflex artery appeared only contrast enhanced in the proximal portion. The day after coronary angiography 128-slice cardiac computed tomography (CT) was performed. Cardiac CT showed a 5×3-cm incomplete thrombosed aneurysm of the proximal bypass with complete thrombotic occlusion of distal bypass grafting. With this diagnosis the patient was referred to a cardiothoracic unit for a second opinion. A surgical intervention was refused due to an increased intraoperative morbidity and occlusion of peripheral bypass portion. A follow-up CAG 10 days after infarction showed complete occlusion of the aneurysm. This case illustrates the utility of multi-slice CT to diagnose SVG aneurysm and influence clinical decisions for further treatment. This is the first report of a spontaneous SVG aneurysm thrombosis under a conservative treatment approach with recovery of the patient after MI. Clinical follow-up five months after infarction was unremarkable.

Large saphenous venous graft aneurysm mimicking atypical mediastinal mass

BACKGROUND

Saphenous venous graft (SVG) aneurysm is a very rare but potentially fatal complication of the coronary artery bypass surgery.

CASE REPORT

We reported a case of 72-year-old man admitted to hospital because of atypical chest pain related to body motions in horizontal position, especially to the left side. Pain was followed by dispnea, palpitations, fatigue, cough, yellow sputum expectorations, as well as elevated temperature. He had had coronary artery bypass grafting (CABG) surgery with saphenous vein grafts (SVGs) to the left anterior descending artery (LAD) and right coronary artery (RCA) 27 years earlier. Chest X-ray revealed a poor-defined shadow in the region of the right atrium. A transthoracic echocardiogram revealed an atypical tumorous mediastinal mass near the right atrium and right ventricle that seemed partially calcified on transesophaeal echocardiography (TEE). CT scan confirmed an atypical mediastinal mass in contact with the right ventricle that might be a right ventricle aneurysm, pericardial cyst or SVG aneurysm. Coronary angiography was performed subsequently and it revealed a big saphenous venous graft aneurysm originating from the previous venous graft to the RCA. The aneurysm was resected and a new bypass graft was placed. Histopathology confirmed a true aneurysm of the venous graft.

CONCLUSION

Although SVG aneurysm is a very rare complication of CABG surgery, patients presenting with atypical hilar or mediastinal mass following CABG should always be evaluated firstly for existence of this cardiosurgical complication.

Percutaneous management of a long saphenous vein graft aneurysm: a case report and review of literature

Aneurysms of saphenous vein grafts are rare but can result in complications such as myocardial infarction or death. Percutaneous treatment has included a variety of approaches, including covered stents. Long aneurysms in saphenous vein grafts pose an additional challenge due to the lack of coronary covered stents with sufficient length. We present successful treatment of a long saphenous vein graft aneurysm with use of peripheral covered stents over two coronary guidewires, a 55-centimeter 8-French sheath and no guide catheter.

Tandem aneurysms of an internal mammary-aortocoronary bypass graft

Graft aneurysms following aortocoronary surgery are a rare occurrence in clinical practice. Reported cases have mostly involved saphenous vein grafts. Here we report the rare finding of a tandem aneurysm of an internal mammary artery graft which was incidentally detected 17 years following bypass surgery. (Neth Heart J 2009;17:300-2.).